Advancing Environmental Equity using PACE-EH

State: TX Type: Model Practice Year: 2012

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HCPHES serves as the local health department for approximately 2 million residents living outside the city of Houston. Through grant funds provided by the W.K. Kellogg Foundation, HCPHES conducted an environmental community assessment project (E-CAP) to identify and address environmental health concerns in the City of Galena Park. E-CAP began in June 2008 and was “completed” in September 2010. Galena Park is home to 10,887 residents and many industries serving the Port of Houston. The City’s limited resources is the main barrier to resolving some of the larger community issues. However, residents work collectively to maximize the community resources that are available.

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Harris County Public Health and Environmental Services
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Advancing Environmental Equity using PACE-EH
HCPHES serves as the local health department for approximately 2 million residents living outside the city of Houston. Through grant funds provided by the W.K. Kellogg Foundation, HCPHES conducted an environmental community assessment project (E-CAP) to identify and address environmental health concerns in the City of Galena Park. E-CAP began in June 2008 and was “completed” in September 2010. Galena Park is home to 10,887 residents and many industries serving the Port of Houston. The City’s limited resources is the main barrier to resolving some of the larger community issues. However, residents work collectively to maximize the community resources that are available. For example, there are monthly food giveaways; school supply drives; an Early Head Start program that enables teen parents to complete high school by providing child care during the school day; a community-based organization that assists young residents with obtaining scholarships for college and jobs; and summer programs for school-aged children. The primary goal of the E-CAP project was to use dialogue as a means to advance environmental equity. In pursuit of this goal, using a modified version of the Protocol for Assessing Community Excellence in Environmental Health (PACE-EH) called PACE-EH Plus, HCPHES objectives were to examine residents’ perceptions of their environment, increase partnership between HCPHES and Galena Park residents, and mobilize and advocate for community and policy changes in Galena Park. The PACE-EH methodology is organized into a series of 13 tasks, which led an E-CAP Action Team (AT) consisting of community members and program managers through an organized series of discussions to develop goals and objectives for an environmental community assessment; identify and prioritize community environmental health issues; analyze those issues using a systems framework; set priorities for action and develop an action plan. In collaboration with MD Anderson Cancer Center, Center for Research on Minority Health PACE-EH Plus was developed to enhance the PACE-EH methodology by creating additional opportunities for enhanced dialogue regarding issues of social/environmental justice and health inequity in the community within these tasks. By applying the PACE-EH Plus methodology, all project objectives were achieved. The main factors that led to the achievement of the project’s objectives include: 1. Explicitly discussing the root causes of environmental conditions in Galena Park. The dialogue surrounding root causes enabled group members to feel comfortable discussing the power dynamic in their community and how this dynamic could potentially influence their ability to address the priority issues they identified. Through dialogue, residents eventually felt compelled to establish the non-profit organization Environmental Community Advocates of Galena Park (ECAGP) to better advocate for improvements in their community. 2. Commitment of Resources from Stakeholders. Commitment of resources and ongoing engagement of community partners/stakeholders have been critical factors leading to many of the achievements throughout the project. For example, partnerships with local environmental groups have provided community members several opportunities to participate in environmental justice conferences at no cost and fostered relationships with other partners that build community capacity to address environmental injustice. These partnerships have also enabled ECAGP to obtain pro-bono legal services to complete the Federal application for their non-profit status, obtain an in-kind donation of office space and the opportunity apply for and be awarded two grants totaling over $200,000. The community is well-equipped with not only the individual skills to sustain these efforts but also with the necessary partnerships and organizational capacity to move toward achieving environmental justice. 3. Advocacy. Another critical component to the success of the project was ongoing advocacy throughout the process. In between official E-CAP meetings, project staff met with numerous community partners/stakeholders to discuss the challenges facing the Galena Park community. In some cases, these meetings have resulted in the establishment of long-term relationships that maintains a focus on the City’s needs. As a result, addressing the community’s challenges is at the forefront of many of the partners/stakeholders agendas. Advocacy on behalf of the community has contributed to tangible benefits to the community, such as the repaving of a major road, in disrepair that runs through Galena Park and was a major source of the community’s air quality issues. The most valuable lesson learned from this practice is that flexibility, perseverance and committed community leadership is needed to be successful. The project went through many fluctuations including periods of great progress but also times when activities/developments were delayed and/or did not occur.
Health Issues The public health issue that this practice sought to address was environmental equity. Equity refers to the fair distribution of benefits and burdens in a population. The E-CAP project sought to enhance equitable environmental conditions in the Galena Park community through a community-based dialogue process which explicitly considered the root causes of environmental and health inequities. The specific environmental challenges facing Galena Park that are uniquely different from other Harris County communities which were prioritized by the E-CAP AT are: Air Quality: Both benzene (a known carcinogen) and particulate matter (fine dust that can affect respiratory and circulatory health) concentrations in the air of Galena Park have exceeded acceptable limits in the past. Access to Health Care: There are no primary care providers that serve adults practicing in the City of Galena Park; HRSA has designated the area as a Primary Care Professional Shortage Area. Built Environment: There are a number of issues with the built environment in the City including, limited public transportation; limited access to healthy food options; few sidewalks/sidewalks in disrepair; and increased potential for lead exposure due to the age of the housing stock in the community. The project’s PACE-EH Plus methodology allowed for the E-CAP AT to define the term “environment” which informed the scope of the assessment. This approach enabled the community’s perception of the environment to serve as the foundation to the selection of priority environmental issues, which helped HCPHES and other E-CAP AT participants shift away from a traditional conceptualization of the environment as purely soil, water and air. As noted, the priority issues identified include air quality, access to healthcare and the built environment. Note that while the project was focused upon environmental equity, the E-CAP AT felt so strongly about access to healthcare that this was included as a priority issue – particularly because of key challenges related to limits in physically accessing healthcare due to community design features of the built environment in Galena Park. For example, the City is land-locked by the train which can create access barriers during emergency situations. Community members have reported several deaths resulting from emergency vehicles being unable to bypass the train. Following the identification of the priority issues, a series of focus groups were held with residents to gain a broader community perspective. After focus group findings confirmed the community’s priorities, the E-CAP AT compiled a list of possible strategies to address these issues and shared these strategies at a “community talk” event held in July 2009. Participants included community members, local stakeholders and local elected officials. Residents who served on the E-CAP AT served as co-facilitators at the event. Strategies presented to the community were aimed at changing practice, policy and the physical and social environment and many encompassed upstream and “mid-stream”-type strategies. Attendees at the event discussed the issues and proposed strategies in a smaller-group breakout format and then individually ranked the proposed strategies for each priority issue based on each strategy’s perceived feasibility and effectiveness. Following the series of tasks outlined in the traditional PACE-EH process and incorporating the PACE-EH Plus modifications, we broadened the scope of investigation of priority issues as well as the range of potential strategies to address those issues to enhance equitable conditions in Galena Park. For example, education on how the infrastructure within a community can impact health outcomes, and dialogue about potential root causes that lead to inequities within such infrastructure led to the group selecting the built environment as one of its priority areas of concern. Based on these information exchanges, through the use of dialogue, community members were able to expand the focus of the priority issues and address topics that are not considered within the traditional realm of environmental factors that influence health. With this improved understanding of how health is impacted by social conditions, the dialogue resulted in an exploration of more upstream policy solutions. For instance, while downstream strategies for improving air quality were discussed (e.g. holding annual air quality education workshops) strategies moving more upstream were also discussed and incorporated in the action plan, such as requiring a health impact assessment of infrastructure projects in the City, minimizing industrial traffic in the community and requiring the use of clean technology in ships and trucks. These strategies are more long-term in nature and will require ongoing dialogue among stakeholders; however, their consideration as possible strategies to improve air quality reflects the knowledge of and subscription to the framework of health equity/social justice—that is, environmental conditions within a community are intrinsically linked to the community’s health status, and these conditions are determined by the basic structure within society that imposes disproportionate burdens on certain populations while dispensing benefits to others. In order to achieve health equity, the social structure and environmental conditions within communities must change in order to provide equitable opportunities for all people to be healthy. Innovation Project staff believed that although the original PACE-EH process includes dialogue, the process is oriented toward quantitatively defining a community and does not explicitly consider root causes of communities environmental health challenges. PACE-EH Plus enhanced existing opportunities for dialogue and created opportunities for explicit dialogue regarding issues of social/environmental justice and health inequity in the process. PACE-EH Plus methodology enabled the group to define the term “environment,” which informed the scope of the assessment and the community’s priority issues beyond the traditional conceptualization of the environment (i.e., air, soil, and water). Additional dialogue among Galena Park residents took place, in the form of focus groups, to verify the E-CAP AT priority issues. Next, the Analyzing Framework template provided in the PACE-EH Guidebook was modified to include “Upstream Factors” which were placed at the top of hierarchy of factors that influence environmental health status (see Attachment 1). Upstream factors consider the social structure in communities beyond public policies and personal behaviors. Upstream factors consider how decisions are made, who is and is not involved in the process and why certain populations are less represented than others in decision-making. These explicit dialogue sessions around the power structures within communities served as the catalyst for further dialogue on how the community could empower itself to better address their priority issues. Tasks 10 and 11 in the original PACE-EH process were also modified. As written, ranking of the issues and setting priorities for action were tasks to be completed by the ECAP AT. However, project staff believed that engaging the broader Galena Park community to engage in dialogue, via a community forum, and providing the forum attendees the opportunity to vote for the strategies based on perceived feasibility and effectiveness, would be more effective than limiting these tasks to the E-CAP AT. The tool is in NACCHO’s Toolbox. As such, several searches of existing literature were performed to determine that the PACE-EH Plus model is an inventive use of the PACE-EH tool. First, a search of the PubMed database using search terms “PACE-EH” resulted in a list of eight citations (Attachment 2). The abstracts of articles identified were reviewed for content to determine how the PACE-EH process was implemented in the specified communities. Based on this review, it was determined that the projects reviewed did not explicitly use a social/environmental equity approach to guide the PACE-EH process as had been done in PACE-EH Plus. Another search was done of NACCHO’s Model Practices database to determine whether the PACE-EH Plus-like process had been previously submitted to and accepted into the database. The same search term was used and several citations were found. Of the projects listed, only one model practice (PACE-EH Marydia: Improvements in a Disadvantaged Community) considered the broader social determinants of health, however the implementation of the projects differed significantly. A third search was performed on Google using the terms “PACE-EH and root causes” and “PACE-EH and environmental justice”. It was assumed that the Google database would provide an unmanageable amount of information if only the term “PACE-EH” was used. Therefore, we applied more selective terminology to identify other communities that may have used a similar approach as PACE-EH Plus. This search did not result in any PACE-EH projects that were implemented in a similar manner as PACE-EH Plus. In our experience, projects that aim to address a community’s environmental health issues are narrowly focused on traditional “environmental” concerns such as air and water. Moreover, the “issue” is often defined by the agency prior to engaging the affected community. The subsequent activities are then framed around the pre-defined issue(s) and the community is not provided adequate opportunities to discuss whether the issue(s) is in fact their community’s priority. However, as mentioned, the scope of “environmental” concerns was not limited during this project and was community defined. Thus, the nature of the approach used was more organic and enabled residents to not only define the issues but also prioritize their importance and select strategies that would eventually be implemented to address them. We believe facilitating a dialogue process through the lens of health equity broadened the scope of investigation of priority issues, the exploration of strategies to address those issues, and the considerations on how to best implement the action plan. For example, education on how the infrastructure within a community can impact health outcomes, and dialogue about potential root causes that lead to inequities within such infrastructure led to the group selecting the built environment as one of its priority areas of concern. Based on these information exchanges, through the use of dialogue, community members were able to expand the focus of the priority issues and address topics that are not considered within the traditional realm of factors that influence health.  
Primary Stakeholders The primary stakeholders in the practice were the residents of Galena Park. Role of Stakeholders/Partners Community residents and other stakeholders/partners have been engaged in both the planning and implementation of E-CAP by regularly attending E-CAP meetings and helping to complete assessments of the Galena Park environment (e.g., walkability/bikability assessment, nutrition assessment, etc.) during the first year of the project and later providing technical assistance for how to best implement the strategies outlined in the community action plan. During the initial phases of the project there were 34 members of the E-CAP AT including community residents of all ages and ethnicities; program managers from local governmental, public health and environmental agencies; local elected officials and their representatives; representatives from the city Public Works and Parks and Recreation Departments; school personnel; local church representative(s); representatives of the League of United Latin American Citizens; a PTA member/school parent; a local law enforcement representative; a Chamber of Commerce representative; a member of the Galena Park and Jacinto City Rotary Club; medical clinic staff; and small business owner(s). Note that stakeholder participation fluctuated throughout the duration of the project – and there are some team members who no longer actively participate (due to a variety of reasons, including changes in health and employment), and some who joined the team later in the process. Other participants who have been engaged in the process include representatives from local and state entities that support efforts to address the priority issues: oAir Quality: Air Alliance Houston, Sierra Club, Environmental Defense Fund, Texas Commission for Environmental Quality, Texas Environmental Justice Advocacy Services (TEJAS), and representatives from local industry, University of Texas Medical Branch. oAccess to Health Care: Gateway to Care, Texas Association of Community Health Centers, Pasadena Health Center, Hospital Corporation of America, Harris County Hospital District, and the Harris County Healthcare Alliance. oBuilt Environment: Texas AgriLife Extension Services, Texas Retailers Association, Harris County Office of Transit Services, and the Citizens Transportation Coalition. These community stakeholders/partners have been instrumental in providing technical expertise, assisting with the identification of resources to implement strategies in the community action plan, serving as liaisons to other community partners/stakeholders, and advocating with and on behalf of the Galena Park community. LHD Role HCPHES had a variety of roles in this project including: Facilitator / Educator A staff member in the HCPHES Office of Policy and Planning was the primary facilitator and project manager of E-CAP. Other participating HCPHES staff from other areas of HCPHES provided education and subject matter expertise in the areas of environmental health (e.g. air quality, lead poisoning, etc), environmental epidemiology, the built environment, and public information. The project manager coordinated the dialogue process for the E-CAP AT, facilitating the implementation of PACE-EH Plus activities such as issue priority-setting, focus groups, action planning and community-capacity building. Throughout the process, other HCPHES staff contributed subject matter expertise through educational presentations and less formal exchanges of information as ECAP AT participants. In addition, a staff member from the HCPHES Office of Public Information provided English-Spanish translation support for both oral and written forms of communication. Data Collector: Assessments/Audits There were a number of assessments that were completed by HCPHES staff in collaboration with community residents, a Galena Park City Councilman, and other stakeholders, including walkability/bikability audits (Pedestrian Environmental Data Scan and the Walking and Biking Suitability Assessment), park audits (resulting in the City’s first Parks Master Plan), and a nutritional assessment (Nutrition Environment Measures Survey) of the local supermarket. The project manager coordinated data collection, data analysis and reporting for the assessments/audits. Advocate HCPHES staff has also advocated on behalf of the Galena Park community in a variety of settings. For example, the project manager has attended ongoing meetings with a local federally qualified health center to discuss options for the provision of adult primary care services in the Galena Park community. While their Board recently voted to postpone expansion into Galena Park (due to budget constraints), the possibility will be reconsidered during the next fiscal year. Ongoing advocacy is critical to achieving change within a community and maintains a community’s visibility on stakeholders’ agendas for future resources that may become available. Relationships with community partners/stakeholders have been an integral component that has led to the “success” of this project. As previously noted, community partners/stakeholders have been engaged, in a variety of roles, during each phase of E-CAP and continue to provide a critical network of support for implementing the community action plan. HCPHES fosters these relationships by providing periodic status updates about the project for partners that may not be engaged on a regular, ongoing basis. However, community partners/stakeholders are also invited to attend meetings when the meeting agenda corresponds to their interests. In addition, they also have the opportunity to share projects they may be leading that benefit the community. This raises awareness among community members that others are advocating on their behalf. It also provides residents the opportunity to become involved in projects that can move them toward enhancing the conditions in their community outside of the E-CAP project. For example, because of an ongoing relationship with local environmental advocacy groups, several members of the E-CAP AT have attended environmental justice conferences at no cost. These opportunities enabled residents to meet and network with others across the country facing similar challenges in their communities and to generate additional ideas about addressing the environmental challenges in Galena Park. In summary, HCPHES fosters the relationships with community/stakeholders through mutual exchanges of information and ideas, ongoing dialogue and participation, and assistance with projects. HCPHES maintains a focus on ensuring all activities are community-based (i.e., that the community chooses to engage and is engaged in the project from the beginning) and that the community is the primary beneficiary of the activity. Lessons Learned Fortunately, there were few barriers to forming the initial collaboration and obtaining agreement from community residents/partners to participate. One lesson learned is that intuitively, community members understand concepts of social determinants of health, health equity and social justice. The dialogue process shed light on the extent to which community members perceive these concepts as influences on their opportunities to be healthy and their perceptions of their power or control to change the infrastructure and policies that perpetuate inequities. For instance, instead of relying on the City to address the priority issues, the group chose an approach that would provide them with more flexibility and power to address the community’s concerns—that is, the establishment of ECAGP. Initial dialogue centered on approaching City Council members to work on behalf of the group to address the priority issues. However, through dialogue, the group recognized that funds, beyond those available to the City, would have to be obtained in order to implement some of the strategies in the plan. The dialogue sessions enabled discussion around topics such as the City’s power to allocate funding to its priority projects which may not necessarily be congruent with the residents’ priority concerns. As a result, the group wanted to control the funds while recognizing they would still need the City’s approval to implement some of the strategies. Another lesson learned was that discussions focusing on issues such as racism, particularly in this community, tend to perpetuate an intra-community divide, either real or perceived. For instance, the Galena Park community is divided both socially and physically by race/ethnicity. There is a small sub-division of homes called Galena Manor in which most of the City’s African American residents live. During dialogue discussions, it was evident that there were differing interests in these respective communities rather than a collective interest of Galena Park. Project staff believed that this initially hindered the implementation of the community action plan. And finally, while the dialogue sessions enabled discussions around these issues community members sometimes became “gridlocked” when there was too much dialogue and few actions aimed at changing their realties. This led to, at least in part, disengagement by a number of community members at various points throughout the project. However, project staff were able to recognize this and modify the dialogue to include not only action planning but also to begin initial implementation of some of the strategies outlined in the plan. This shift led to a reengagement of some community members and positively impacted the ongoing involvement of some community partners (e.g., Air Alliance Houston). Despite the noted challenges, the dialogue process enabled community members, as well as project staff, to embrace the health equity/social justice framework. This resulted in the development of priority issues and strategies to address them that are more comprehensive and seek to address some of the fundamental structural inequities more often experienced in communities of low-income and/or color (e.g. distribution of funds to build and/or repair roads and parks). Implementation Strategy The project’s methodology allowed for the achievement of the first objective, examining residents’ perceptions of their environment. The dialogue also informed the scope of the assessment and determined the community’s priority issues. This approach enabled us to capture the community’s perception of the environment holistically. Dialogues about the environment included the social, physical, built environments or a combination of all of the above which has allowed for greater freedom in including experiences that would not be addressed in the traditional conceptualization of environment as being purely soil, water, and air. Further, there was discussion about the root causes of each topic. Focus groups with other community members were then held to determine the perceptions of the broader community. Project staff achieved the second objective of the project, to increase partnership, by developing relationships with residents and engaging with them on all aspects of the project. For example, to obtain primary data on the built environment in the community, the team worked together to conduct several neighborhood-level assessments including walkability/bikability audits; audits of each local park, which led to the development of the city’s first Parks Master Plan; and an assessment of the nutrition environment at the city’s local grocery store. Finally, the third objective to mobilize and advocate for community and policy changes was achieved by linking residents with organizations that could build their capacity to address their environmental concerns. For example, the Environmental Support Center has provided residents with training on several topics essential for success as a non-profit organization, such as fundraising. The timeline for carrying out the aforementioned tasks was as follows: July 2008 – March 2009: Focused on education, dialogue and assessing the community’s environment. During this time, information regarding the residents’ perception of their environment was gathered through dialogue-based information exchanges and data collection on the built environment, health indicators, etc. was obtained. April 2009 – July 2009: Focused on planning for action and setting priorities for action. This was done by identifying successful strategies that had been used in communities facing similar challenges. The broader community was then given the opportunity to vote on their preferred strategies that would later be implemented by the residents in collaboration with appropriate community partners. August 2009 – March 2010: Focused on developing the community action plan and resources that would assist the residents in implementing the plan. (March 2010: The Environmental Community Advocates of Galena Park is established) April 2010 – September 2010: During this time, community members obtained training from various organizations on a variety of topics and began identifying funding sources to further the implementation of the community action plan. For example, Midwest Academy provided training on community organizing and the community began their first grant application. (Note that HCPHES project period technically ended September 2010 per our grant with Kellogg Foundation) November 2010 – Current: Community members continue to implement the tasks outlined in the community action plan with ongoing assistance from HCPHES and other community partners.  
Process & Outcome HCPHES contracted with MD Anderson Cancer Center, Center for Research on Minority Health to conduct a process and outcome evaluation of the community assessment. All evaluation results were provided to HCPHES. Satisfaction survey results were shared with members of the E-CAP AT. Objective 1: Use dialogue to examine residents’ perceptions of their environment. A number of qualitative measures were used to assess the extent to which the dialogue process captured residents’ perceptions of their environment. Some examples include: 1. Was a community dialogue process used to determine how the residents of Galena Park perceived that their environment might affect their health status? 2. Was a community dialogue process used to determine how the residents of Galena Park perceived environmental factors as root causes of health disparities, environmental inequities, or social injustices? 3. Have the major environmental health concerns of Galena Park residents been identified using both quantitative and qualitative data collection methods? Have health disparities and social injustices been identified using quantitative and qualitative data collection methods? Evidence/Data: Transcripts of focus group sessions, summarized findings from the E-CAP AT community dialogue sessions and sign-in sheets were used to evaluate these measures. Additional environmental data specific to the Galena Park community were collected to compare the residents’ perceptions and concerns. Specifically, data were obtained from TCEQ and HCPHES to determine the extent to which community perceptions of environmental challenges were supported with any available quantitative data. Evaluation Findings: The project staff was responsible for gathering, analyzing and reporting this data to the MD Anderson assigned expert. The evaluation of this measure is provided below. The major environmental health concerns of Galena Park residents were identified using both qualitative and quantitative data collection methods. Quantitative data related to environmental exposures specific to the Galena Park community were also presented to the E-CAP AT during dialogue sessions focused on these issues. The adverse effects of environmental exposures were discussed during E-CAP AT meetings. Terms such as root causes, health disparities, environmental inequities and social injustices were defined during initial meetings with the E-CAP AT. Root causes of health disparities, environmental inequities and social injustices were then discussed in each of the subsequent E-CAP AT meetings, particularly during the completion of Task 6 of the PACE-EH process, which is to analyze the issues using a systems framework. Additionally, Root Causes Analyses were completed to identify environmental health concerns, social determinants of environmental health and health disparities. The identified root causes included Literacy, Income/SES, Education, Unemployed, Poverty, Community Surroundings (changes to the industries), Policy (city or lack of), Transportation, Stress, Lack of Empowerment, Racism and Language. E-CAP AT meetings and focus group discussions provided qualitative data on the major environmental health concerns of Galena Park residents. Evidence of the community dialogue process were noted in transcripts of E-CAP AT meetings and focus groups, as well as copies of presentation slides containing environmental data specific to Galena Park. Additionally, quantitative data related to healthcare access and utilization, mental health, communicable diseases and obesity in Harris County and the Galena Park community were presented. While qualitative data from the E-CAP AT meetings and focus group discussions demonstrated perceived health disparities and social injustices, quantitative data collected to date did not confirm the identified perceptions. Specific health disparities and social injustices were not confirmed by the quantitative data available however, it is important to note, the data available were limited. Feedback: The results of the process evaluation have only been shared with HCPHES staff. The results from this evaluation revealed that, in some cases, it is difficult to quantify health inequities as it relates to communities’ environmental exposures. The “disconnect” between communities perceptions and the data to validate their perceptions can lead to frustration by all stakeholders involved. To address this issue, the group has started discussions with a local university who is interested in developing a community-based participatory research project to examine community reports of excess asthma among children and cancer cases among adults. Objective 2: Increase partnerships between HCPHES and Galena Park residents. Project staff aimed for at least 50% of the group’s composition to include Galena Park residents to ensure that the community’s voice was adequately represented and reflected throughout the process. To evaluate the partnership and participant perceptions of the E-CAP project, a satisfaction survey was developed so that it could be administered at various phases of the project, Measure: General satisfaction with the process as well as perceptions of the impact of the project on the Galena Park community. The response scale options were Strongly Agree (5), Agree (4), Neutral (3), Disagree (2) and Strongly Disagree (1) for the following survey items: ?I am generally satisfied with the activities of the E-CAP AT. ?I have a sense of ownership in what the E-CAP AT does and hopes to accomplish. ?I am satisfied with the type of work that the E-CAP AT hopes to accomplish. ?The E-CAP AT has been effective in defining its goals and expectations. ?The E-CAP AT can have a positive effect on the Galena Park community. ?Participation in the E-CAP AT has increased my knowledge and understanding of the Galena Park community and other member organizations of the team. ?The roles and expectations of an E-CAP AT member have been clearly defined. ?The use of personal time to participate in E-CAP activities is well spent. Evidence/Data: The MD Anderson Cancer Center evaluator was responsible for administering the survey and analyzing the responses. Eleven (11) and nine (9) E-CAP AT members completed cycle 1 and 2 of the satisfaction survey, respectively. Evaluation: Overall, E-CAP participants have been highly satisfied with E-CAP activities and their role in the process however, it is important to note that the findings reflect the views of roughly one third of the E-CAP AT members. Feedback: The satisfaction survey results were used to gauge perceptions of the effectiveness and usefulness of the project from the E-CAP AT. While the data collected provided insight to the group’s overall satisfaction, it did not provide insight into some of the challenges the group experienced, such as inconsistent meeting attendance. Future community assessment processes should incorporate a qualitative component to assess challenges that may be experienced during the process and obtain feedback on how to address those challenges. Objective 3: Mobilize and advocate for community and policy changes in Galena Park. The E-CAP AT developed a set of process and outcome measures to monitor and track progress toward the strategies outlined in the community action plan (developed during Task 12 of the PACE-EH process). The strategies in the action plan aim to achieve both community and policy changes in Galena Park. Measure: Due to the extensive number of process and outcome measures in the action plan, an example of one process and outcome measure for each priority issue is provided. Air Quality Process Indicator: Install a minimum of one new air monitor in Galena Park that will capture benzene emissions 24 hours/day 7 days/week. (Data Source: HCPHES) Outcome Indicator: Reduce emissions events by 25% in 2011. (Data Source: HCPHES) Access to Health Care Process Indicator: 100% of Galena Park households that receive a water utility bill will receive an annual update with information on health services and clinics that are able to serve Galena Park residents, by 12/31 of each year. (Data Source: Verbal Confirmation of Mail-Out from City residents) Outcome Indicator: At least 3 Galena Park residents will be trained as community health workers by Dec. 2011. (Data Source: Gateway to Care Enrollment Data) Built Environment Process Indicator: At least 25 children in Galena Park will be tested for lead each year. (Data Source: GPISD/HCPHES) Outcome Indicator: At least 3 Galena Park residents will be trained and certified in lead abatement by Dec. 2011. (Data Source: HCPHES) Evaluation: The community action plan was “finalized” in September 2010; therefore a formal evaluation of these indicators has not yet been completed. However, it is worth noting that a number of these measures have already been achieved. With regard to air quality, a new air monitor was placed in Galena Park in 2011. With regard to lead abatement certification, four Galena Park residents have been trained and certified. As noted previously, much of the City’s housing stock was built prior to Federal legislation prohibiting the use of lead-based paint, putting residents at-risk of lead exposure. The program was advertised via the City’s water utility bill and City residents seized the opportunity. This certification translates into potential job opportunities for these residents as well as increased community capacity to remove lead from homes in the community. Evidence of an institutional policy change that resulted from the project is captured by a memorandum of understanding between Galena Park Independent School District’s Early Head Start Program and HCPHES whereby HCPHES has agreed to now provide lead testing (twice a year) for children newly enrolled in the Early Head Program at no cost. The first testing was done in February 2010. Feedback: There have been additional advancements that are not captured in the action plan evaluation that also demonstrate success in fulfilling the objective to mobilize and advocate for community and policy changes in Galena Park. As previously mentioned, Galena Park residents have been motivated to establish their own grassroots environmental advocacy organization, ECAGP. The establishment of this organization serves as compelling evidence that the community has been successfully mobilized and is working towards maintaining sustainable efforts to achieve environmental equity in Galena Park. ECAGP has successfully written two grants, in collaboration with partner organizations, which has enabled them to hire a Community Outreach Director and host the organization’s first environmental education workshop. Overall, these developments demonstrate the value of conducting community assessments that are truly rooted in the community and applying a social and environmental equity lens to more fully understand how challenges in a community are brought to bear in the first place.
There is ongoing stakeholder commitment to sustaining this “project”. As mentioned, community residents established their own organization to continue advocating for changes within their community. The organization has built partnerships with other organizations internal and external to the community. For example, ECAGP has partnered with members of the Galena Park Resource and Training Center, the local Rotary Club, Air Alliance Houston, among others to facilitate the implementation of the strategies outlined in their community action plan. These partnerships have provided opportunities for these organizations to leverage resources to further their causes and work toward common goals. For example, ECAGP co-hosted the third annual Environmental Justice Encuentro in collaboration with the Texas Environmental Justice Advocacy Series (TEJAS) and Air Alliance Houston and it is now a part of a network of environmental justice advocates in other port cities in Texas, Louisiana and California. The event was very successful in bringing together local and non-local environmental justice communities. Additionally, the Encuentro provided the communities to meet with the Environmental Protection Agency’s Region 6 Administrator, Dr. Al Armendariz, to voice concerns and demonstrate the impact of environmental issues in their communities. The community is well positioned to sustain the advocacy efforts initiated by HCPHES. As mentioned, residents established their own community-based organization whose mission is to improve the environmental quality of life of the community. To that end, in collaboration with a local community partner, the organization has secured funding for two years for a Community Outreach Director to continue implementation of the community’s action plan. The following activities will take place over the next two years to continue working toward environmental equity in Galena Park: 1) Quarterly community air quality education workshops (funded by the Archdiocese of Galveston Houston): 2) Community Mapping Project (funded by Houston Endowment): The Pacific Institute’s Communities Strategies for Sustainability and Justice Program will plan and facilitate workshops to teach community mapping techniques to support social and economic change at the community level. The University of Texas, Medical Branch (UTMB), Center in Environmental Toxicology and the Center to Eliminate Health Disparities will assist the organization with developing the maps. 3) Health Assessment Survey: Volunteers will canvass up to 2700 households to collect data on health issues in the community. 4) Ground-Truthing Project: Community field workers will identify hazardous sites in and around the community and “ground-truth” their data with existing governmental agency data. The information will be used to develop plans for action, if appropriate. Collectively, these activities sustain the efforts toward achieving environmental equity in Galena Park. In addition to the activities noted above, the organization has established a Healthy Produce Buyer’s Club to enhance access to healthy food for community residents and have started discussions with the local school district to expand its school-based health clinic to offer services to adults.
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